I 

114TH CONGRESS 

1ST SESSION H. R. 4266 

To direct the Secretary of Labor to issue an occupational safety and health 

standard to reduce injuries to patients, nurses, and all other health 

care workers by establishing a safe patient handling, mobility, and injury 

prevention standard, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2015 

Mr. CONYERS (for himself, Mr. SCOTT of Virginia, Ms. WILSON of Florida, 

Mr. CLAY, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. DANNY K. 

DAVIS of Illinois, Mrs. BEATTY, and Ms. GRAHAM) introduced the following bill; which was referred to the Committee on Education and the 

Workforce, and in addition to the Committees on Energy and Commerce 

and Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To direct the Secretary of Labor to issue an occupational 

safety and health standard to reduce injuries to patients, 

nurses, and all other health care workers by establishing 

a safe patient handling, mobility, and injury prevention 

standard, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; FINDINGS; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Nurse and Health Care Worker Protection Act of 2015’’. 

4 (b) FINDINGS.—Congress finds the following: 

5 (1) In 2014, registered nurses ranked sixth 

6 among all occupations for the number of cases of 

7 musculoskeletal disorders resulting in days away 

8 from work, with 11,360 total cases. Nursing assist9 ants reported 20,020 cases in 2014, the second high10 est of any profession. The leading cause of these 

11 health care employees’ injuries is patient lifting, 

12 transferring, and repositioning injuries, which con13 stitute a significant risk to the health and welfare of 

14 those employees under the Occupational Safety and 

15 Health Act of 1970. 

16 (2) The physical demands of the nursing pro17 fession lead many nurses to leave the profession. 

18 Fifty-two percent of nurses complain of chronic back 

19 pain and 38 percent suffer from pain severe enough 

20 to require leave from work. Many nurses and other 

21 health care workers suffering back injury do not re22 turn to work. These consequences constitute a mate23 rial impairment of health for these employees under 

24 the Occupational Safety and Health Act of 1970. 

25 (3) Patients are not at optimum levels of safety 

26 while being lifted, transferred, or repositioned manuVerDate Sep 11 2014 23:44 Dec 21, 2015 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4266.IH H4266

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1 ally. Appropriate mechanical lifts can substantially 

2 reduce skin tears and pressure ulcers suffered by pa3 tients and the frequency of patients being dropped, 

4 thus allowing patients a safer means to progress 

5 through their care and avoid disabling injuries due 

6 to unsafe practices. 

7 (4) The development of assistive patient han8 dling technology, equipment, and devices has essen9 tially rendered the act of strict manual patient han10 dling outdated and typically unnecessary as a func11 tion of nursing care. 

12 (5) A growing number of health care facilities 

13 that have incorporated patient handling technology 

14 and practices have reported positive results. Injuries 

15 among nursing staff and health care workers have 

16 dramatically declined at health care facilities imple17 menting safe patient handling technology, equip18 ment, devices, and practices. As a result, the number 

19 of lost work days due to injury and staff turnover 

20 has declined. Studies have also shown that assistive 

21 patient handling technology successfully reduces 

22 workers’ compensation costs for musculoskeletal dis23 orders. 

24 (6) A number of States have implemented safe 

25 patient handling, mobility and injury prevention 


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1 standards. The success of these programs at the fa2 cility and State level demonstrates the technological 

3 and economical feasibility of such standards. 

4 (7) Establishing a safe patient handling, mobil5 ity, and injury prevention standard for direct-care 

6 registered nurses and other health care workers is a 

7 critical component reasonably necessary for pro8 tecting the health and safety of nurses and other 

9 health care workers, addressing the nursing short10 age, and increasing patient safety. 

11 (c) TABLE OF CONTENTS.—The table of contents of 

12 this Act is as follows: 

Sec. 1. Short title; findings; table of contents. 

Sec. 2. Safe patient handling, mobility, and injury prevention standard. 

Sec. 3. Application of safe patient handling, mobility, and injury prevention 

standard to facilities receiving Medicare and Medicaid funds. 

Sec. 4. Nonpreemption. 

Sec. 5. Definitions. 

13 SEC. 2. SAFE PATIENT HANDLING, MOBILITY, AND INJURY 

14 PREVENTION STANDARD. 

15 (a) RULEMAKING.—Notwithstanding any other provi16 sion of law, not later than 1 year after the date of enact17 ment of this Act, the Secretary of Labor shall, pursuant 

18 to section 6 of the Occupational Safety and Health Act 

19 of 1970 (29 U.S.C. 655), promulgate an interim final 

20 standard on safe patient handling, mobility, and injury 

21 prevention (in this section such standard is referred to as 

22 the ‘‘safe patient handling, mobility, and injury prevention 


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1 standard’’) to prevent musculoskeletal disorders for direct2 care registered nurses and all other health care workers 

3 handling patients. The interim final standard shall remain 

4 in effect until it is replaced by a final safe patient han5 dling, mobility, and injury prevention standard. 

6 (b) REQUIREMENTS.—The safe patient handling, mo7 bility, and injury prevention standard shall require the use 

8 of engineering and safety controls to perform handling of 

9 patients and to reduce the incidence of injuries from man10 ual handling of patients by direct-care registered nurses 

11 and all other health care workers, through the develop12 ment of a comprehensive program, to include the use of 

13 mechanical technology and devices to the greatest degree 

14 feasible. Where the use of mechanical technology and de15 vices is not feasible, the standards shall require the use 

16 of alternative controls and measures to minimize the risk 

17 of injury to nurses and health care workers resulting from 

18 the manual handling of patients. The standard shall apply 

19 to all health care employers, shall generally align with 

20 interprofessional national safe patient handling, mobility, 

21 and injury prevention standards, and shall include the fol22 lowing: 

23 (1) PROGRAM DEVELOPMENT.—A requirement 

24 that each health care employer shall develop and im25 plement a safe patient handling, mobility, and injury 


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1 prevention program within 6 months of the date of 

2 promulgation of the interim final standard, which 

3 program shall include hazard identification, risk as4 sessments, and control measures in relation to pa5 tient care duties and patient handling. 

6 (2) TECHNOLOGY AND EQUIPMENT PURCHASE

7 AND MANAGEMENT.—A requirement that, within 2 

8 years of the date of issuance by the Secretary of an 

9 interim final standard, each health care employer 

10 shall purchase, use, maintain, and make accessible 

11 to health care workers, such safe patient handling 

12 equipment, technology, and accessories as the Sec13 retary determines appropriate. 

14 (3) HEALTH CARE WORKER PARTICIPATION.—A 

15 requirement that each health care employer shall ob16 tain input from health care workers, to include di17 rect care registered nurses, health care workers, 

18 their representatives, and their collective bargaining 

19 agents, in developing and implementing the safe pa20 tient handling, mobility, and injury prevention pro21 gram, including training and education and the pur22 chase of technology and equipment and necessary 

23 accessories. 

24 (4) DATA TRACKING AND REVIEW.—A require25 ment that each health care employer shall establish 


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1 a review program to analyze data relevant to the im2 plementation of the employers’ safe patient handling, 

3 mobility, and injury prevention program, and shall 

4 account for circumstances where safe patient han5 dling technology or equipment were not utilized in 

6 accordance with the health care employers’ safe pa7 tient handling, mobility, and injury prevention 

8 standard. Each health care employer shall upon re9 quest, make available their findings and data used 

10 in such review, to health care workers, their rep11 resentatives, their collective bargaining agents, and 

12 the Secretary or other Federal agency. Each health 

13 care employer shall maintain the data and findings 

14 from their review for at least 5 years 

15 (5) INCORPORATION OF TECHNOLOGY INTO FA16 CILITIES.—A requirement that each health care em17 ployer shall consider the feasibility of incorporating 

18 safe patient handling technology as part of process 

19 of new facility design and construction, or facility re20 modeling. 

21 (6) EDUCATION AND TRAINING.—A require22 ment that each health care employer shall train 

23 health care workers on safe patient handling, mobil24 ity, and injury prevention policies, technology, equip25 ment, and devices, initially, and on a continuing anVerDate Sep 11 2014 01:39 Dec 22, 2015 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4266.IH H4266

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1 nual basis, and as necessary. Such training shall 

2 prepare health care workers, to identify, assess, and 

3 control musculoskeletal hazards of a general nature, 

4 and those specific to particular patient care areas, 

5 and shall be conducted by an individual with knowl6 edge in the subject matter, and delivered, at least in 

7 part, in an interactive simulated point-of-care train8 ing and hands-on format that reflects the specific 

9 demands of a health care workers’ duties. 

10 (7) NOTICE OF SAFE PATIENT HANDLING AND

11 RIGHTS UNDER THIS ACT.—A requirement that each 

12 health care employer shall post a uniform notice in 

13 a form specified by the Secretary that— 

14 (A) explains the safe patient handling, mo15 bility, and injury prevention standard; 

16 (B) includes information regarding safe 

17 patient handling, mobility, and injury preven18 tion policies and training; 

19 (C) explains procedures to report patient 

20 handling-related injuries; and 

21 (D) explains health care workers’ rights 

22 under this Act, including any whistleblower pro23 tections. 

24 (8) ANNUAL EVALUATION.—A requirement that 

25 each health care employer shall conduct an annual 


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1 written evaluation of the implementation of the safe 

2 patient handling, mobility, and injury prevention 

3 program, including handling procedures, selection of 

4 technology, equipment, and engineering controls, as5 sessment of injuries, and new safe patient handling, 

6 mobility, and injury prevention technology and de7 vices that have been developed. The evaluation shall 

8 be conducted with the involvement of nurses, other 

9 health care workers, their representatives, and their 

10 collective bargaining agents, and their input shall be 

11 documented in the evaluation. Health care employers 

12 shall take corrective action as recommended in the 

13 written evaluation. 

14 (9) RIGHT TO REFUSE UNSAFE ASSIGNMENT.— 

15 A requirement that each health care employer shall 

16 provide procedures under which a health care worker 

17 or employee may refuse to perform the employee’s 

18 duties if the employee has a reasonable apprehension 

19 that performing such duties would violate the safe 

20 patient handling, mobility, and injury prevention 

21 standard, and would result in injury or impairment 

22 of health to the health care worker, other health 

23 care workers, or patients. Where practicable, the 

24 health care worker must have communicated the 

25 health or safety concern to the health care employer 


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1 and have not been able to obtain a correction of the 

2 violation. 

3 (c) INSPECTIONS.—The Secretary of Labor shall con4 duct unscheduled inspections under section 8 of the Occu5 pational Safety and Health Act of 1970 (29 U.S.C. 657) 

6 to ensure implementation of and compliance with the safe 

7 patient handling, mobility, and injury prevention stand8 ard. 

9 SEC. 3. APPLICATION OF SAFE PATIENT HANDLING, MOBIL10 ITY, AND INJURY PREVENTION STANDARD TO 

11 FACILITIES RECEIVING MEDICARE AND MED12 ICAID FUNDS. 

13 (a) IN GENERAL.—Section 1866 of the Social Secu14 rity Act (42 U.S.C. 1395cc) is amended— 

15 (1) in subsection (a)(1)(V), by inserting ‘‘and 

16 safe patient handling, mobility, and injury preven17 tion standard (as initially promulgated under section 

18 2 of the Nurse and Health Care Worker Protection 

19 Act of 2015)’’ before the period at the end; and 

20 (2) in subsection (b)(4)— 

21 (A) in subparagraph (A), by inserting 

22 ‘‘and the safe patient handling, mobility, and 

23 injury prevention standard’’ after ‘‘Bloodborne 

24 Pathogens standard’’; and 


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1 (B) in subparagraph (B), inserting ‘‘or the 

2 safe patient handling, mobility, and injury pre3 vention standard’’ after ‘‘Bloodborne Pathogens 

4 standard’’. 

5 (b) EFFECTIVE DATE.—The amendments made by 

6 subsection (a) shall apply to health care facilities 1 year 

7 after date of issuance of the final safe patient handling, 

8 mobility, and injury prevention standard required under 

9 section 2. 

10 SEC. 4. NONPREEMPTION. 

11 (a) EFFECT ON OTHER LAWS.—Nothing in this Act 

12 shall be construed to— 

13 (1) preempt any law, rule, or regulation of a 

14 State or political subdivision of a State, unless such 

15 law, rule, or regulation is in conflict with this Act 

16 or a regulation or order issued under this Act; 

17 (2) impair or diminish in any way the authority 

18 of any State to enact and enforce any law which pro19 vides equivalent or greater protections for employees 

20 engaging in conduct protected under this Act; 

21 (3) curtail or limit in any way the right of peo22 ple with disabilities under the Americans with Dis23 abilities Act (42 12101 et seq.) or section 504 of the 

24 Rehabilitation Act of 1973 (29 U.S.C. 794) to those 

25 reasonable modifications needed to receive equal acVerDate Sep 11 2014 23:44 Dec 21, 2015 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4266.IH H4266

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1 cess to health care, including the requirement that 

2 health care employees give priority consideration to 

3 the lifting, movement, or transfer needs and pref4 erences of people with disabilities; or 

5 (4) curtail or limit in any way consideration as 

6 an expenditure to acquire or modify equipment for 

7 use by or to benefit individuals with disabilities that 

8 is specified in section 44 of the Internal Revenue 

9 Code of 1986, which is available to eligible small 

10 businesses. 

11 (b) RIGHTS RETAINED BY HEALTH CARE WORK12 ERS.—Nothing in this Act shall be construed to diminish 

13 the rights, privileges, or remedies of any health care work14 er or employee under any Federal or State law, or under 

15 any collective bargaining agreement. 

16 SEC. 5. DEFINITIONS. 

17 For purposes of this Act: 

18 (1) DIRECT-CARE REGISTERED NURSE.—The 

19 term ‘‘direct-care registered nurse’’ means an indi20 vidual who has been granted a license by at least 

21 one State to practice as a registered nurse and who 

22 provides bedside care or outpatient services for one 

23 or more patients or residents. 

24 (2) EMPLOYEE.—The term ‘‘employee’’ means 

25 any individual employed by a health care employer, 


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1 to include health care workers, as well as employees 

2 who do not qualify as health care workers, including 

3 independent contractors. 

4 (3) EMPLOYMENT.—The term ‘‘employment’’ 

5 includes the provision of services under a contract or 

6 other arrangement. 

7 (4) HANDLING.—The term ‘‘handling’’ includes 

8 actions such as lifting, transferring, repositioning, 

9 mobilizing, moving, or any other action involving the 

10 physical movement, manipulation, or support of a 

11 patient by a health care worker, or any direct pa12 tient care action which presents a risk of musculo13 skeletal injury. 

14 (5) HEALTH CARE EMPLOYER.—The term 

15 ‘‘health care employer’’ means an outpatient health 

16 care facility, hospital, nursing home, home health 

17 care agency, social assistance facility or program, 

18 hospice, federally qualified health center, nurse man19 aged health center, rural health clinic or rehabilita20 tive center, or any similar health care facility that 

21 employs direct-care registered nurses or other health 

22 care workers. 

23 (6) HEALTH CARE WORKER.—The term ‘‘health 

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1 tient handling, including direct-care registered 

2 nurses, independent contractors, or individuals who 

3 perform the duties of health care workers. 

Æ 


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